NEA Report Highlights Atopic Dermatitis Care Access Gaps by State

The National Eczema Association (NEA) has released the State of AD 2026 National Indicator Report, a Milliman analysis estimating diagnosed atopic dermatitis (AD) in about 2.3% of insured Americans, or roughly 6.9 million people, in 2023. The report draws on commercial, Medicare fee-for-service (FFS), and Medicaid claims and encounter data, and NEA published state-specific briefs for all 50 states and the District of Columbia.¹

The work is part of a 4-year, NEA-led initiative funded by the Centers for Disease Control and Prevention to build the first comprehensive national and state-level estimates of AD diagnosis and care across all ages and major insurance types.² Surveys, claims studies, and smaller data sets rarely allowed comparison across age, insurance type, and geography at once, according to Tenesha Wallace Hood, MA, director of healthcare provider engagement at NEA, in an exclusive interview with Dermatology Times.

"We hope this report gives healthcare providers as well as public health professionals and policymakers a shared data foundation,” Wallace Hood said.

Diagnosed AD prevalence was highest in the Medicare FFS market (3.0%), followed by Medicaid (2.2%) and commercial insurance (2.1%). Prevalence was higher among children than adults, higher among females than males, and higher in urban than rural areas across all 3 markets. The Milliman authors noted market differences likely reflect demographics, true disease burden, and care-seeking and coding patterns rather than direct measures of disease risk.¹

About 10% to 15% of patients with diagnosed AD also had asthma, and 8% to 15% had skin infections. Fewer than 1% had an AD-related acute inpatient admission, while emergency department or observation visits affected 1.2% to 4.6% and urgent care visits affected 2.5% to 5.2%.¹

Care was concentrated in the office setting. Between 81% and 94% of patients had at least 1 office visit for any reason in 2023, and roughly 50% to 58% had at least 1 AD-related office visit. Dermatologists and dermatology advanced practice providers (APPs) accounted for approximately 42% to 60% of AD-related office visits after age and sex adjustment.¹

Dermatology APPs, including nurse practitioners and physician assistants, rendered 26% to 37% of all-cause dermatology office visits, with higher reliance in rural areas.¹Telehealth accounted for 2.8% to 3.6% of AD-related office visits overall and just 1.2% to 1.3% of dermatology visits.¹

Systemic Corticosteroid Use and Dermatology Access Gaps in AD Care

Approximately half of patients with diagnosed AD filled at least 1 AD-related prescription in 2023, ranging from 47% in the commercial market to 54% in the Medicare FFS and Medicaid markets. Topical corticosteroids were the most commonly filled therapy, with 42% to 52% of patients filling at least 1 prescription by market. Systemic therapy use was low overall.¹

Dupilumab (Dupixent; Regeneron Pharmaceuticals and Sanofi) was used by 2% to 4% of patients with diagnosed AD, making it the most commonly used guideline-based systemic therapy. Systemic corticosteroids (SCS) identified as AD-related were filled by 4% to 5% of patients, despite clinical practice guidelines recommending against their use because of rebound flares and adverse effects with prolonged use. Oral Janus kinase inhibitors and conventional immunosuppressants were each used by fewer than 1% of patients in most markets.¹

“The claims data can tell us what prescriptions are filled, but it can't tell us all of the clinical circumstances behind those decisions,” Wallace Hood said.

Dermatology and allergy/immunology practitioner density averaged approximately 7.5 per 100,000 population nationwide, but state-level density varied by more than threefold. The District of Columbia ranked highest at 15.2 per 100,000, while Oklahoma had the lowest at 4.4. Approximately 13% of the US population lived in counties with no dermatology or allergy/immunology practitioners.¹

The authors cautioned registry data likely undercount APPs, particularly those in multispecialty practices.¹

Survey-based estimates have historically run higher than the claims-based figure, ranging from 6.0% to 16.9% among children and 4.9% to 10.4% among adults. Wallace Hood said milder disease never reaching care, diagnostic challenges, and access barriers may explain part of the gap. In her words, "diagnosed prevalence is not the same as everyone living with AD."

On SCS use, Wallace Hood said the finding is "a signal worth examining, but I don't think it's a judgment about individual care." She noted claims data capture fills but not clinical circumstances such as disease severity, and systemic steroids may be prescribed for coexisting conditions such as asthma.

Wallace Hood said NEA plans to use the data in healthcare professional education and to develop resources for providers who see eczema outside dermatology. The state briefs, available at stateofAD.org, are intended to help health systems, payers, and policymakers examine workforce, access, and coverage locally.¹

The authors noted prescription claims do not capture over-the-counter therapies, including low-potency topical corticosteroids and emollients.¹

"The data alone doesn't change care, but it helps us understand where there may be possibilities to improve it…. We know every state has something it can improve upon. We want this data to be a starting point for those conversations and ultimately lead to timely action,” Wallace Hood concluded.

Stay tuned for the exclusive interview with Wallace Hood coming soon.

References

1. Hansen D, Bazell C, Pelizzari P, McPherson R. The State of Atopic Dermatitis in the United States. National Eczema Association. 2026. Accessed October 1, 2026.
2. State of AD: The First National Picture of Atopic Dermatitis in America. National Eczema Association. 2026. Accessed October 1, 2026. https://stateofad.org/about-the-project/